being and opportunity in the world is noticeably unequal. And we believe that those of us (like the writers and readers of this book) who do relatively well in terms of that distribution should consider seriously what they can do to improve the lot of our fellow human beings who suffer from real deprivation. Third, for all of its difficulty and frustration, pharmaceutical sector reform is an arena that can offer great personal satisfaction. It is work in which intelligence, passion, imagination, and critical thinking can all make a real difference. Doing this work requires an appreciation of many aspects of a very complex system—from politics and economics, to social and cultural beliefs, to biological processes, organizational dynamics, and philosophical commitments. It offers opportunities for leadership and craftsmanship, for learning and creating in the process of doing work that is truly worth doing. And that cannot be said of all forms of work in the world. Unfortunately, we cannot offer a simple, cookie-cutter solution to the political, ethical, and practical dilemmas that reformers will confront. Nor do we have a single formula for how to adjust the control knobs to achieve the greatest improvements in pharmaceutical sector performance. We do believe, however, that explicit discussion of the problems and public deliberation about the issues involved can assist reformers in reaching good decisions, as well as satisfying the conditions for democratic accountability. Ultimately, reformers need experience and practice in using the control knobs, and that is why we have included the cases in the book. Stories are an important mechanism for capturing and conveying knowledge, and we hope readers may be moved to reread some of them as they go forward with their reform efforts. But studying any book on how to do reform—even this one—can only take you so far. In the end, the question is, How can you apply these ideas in practice, in your particular social, economic, and political context? On that score, we hope that our advice and ideas are helpful. We wish you courage and good luck on your path to reform and improved performance and equity in the pharmaceutical sector.
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